The CIARC (formerly SMRC) at CWRU and University Hospitals Eye Institute, established over 20 years ago as a reading center for corporate studies examining the effect of medications, surgery, and preservation media on the corneal endothelium (43-51), has served as the endothelial image analysis reading center for the SMAS since 2000. The CIARC has become a leader in the field as a result of its development of a classification system for endothelial image quality and variable frame ECD determination employing a dual grading and adjudication system.(2, 5-7) Over this period of time the CIARC has analyzed over 229 eye bank images and >3000 clinical image sets from the SMAS alone. In the past three years the CIARC has extended its efforts to endothelial image analysis of both specular and confocal images following EK (32, 42) and the application of morphometric image analysis techniques to the SMAS images which have relevance to this proposal.